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i <br /> ieveretl CHART NO. �-�..�� <br /> ' � P�'S �G�'/�"' . <br /> t � <br /> i Z - /7 -� 7g' -� <br /> �i City of Everett //e� ; <br /> Engineering & Community Sarvices <br /> � S�ewer Appiication and Permit <br /> I <br /> , <br /> N0. � ' U ;� �.i DATE ���-�':� _ :. � <br /> i — <br /> � <br /> I Service Address !'f%::` p��� <br /> � Utility Account No. - � ��� - ;: ✓ <br /> iBilling Address=_ - � -- r Permit Fee .' �% '1`- <br /> � City,State, Zip : /.' , --- <br /> Connection Charge(s) - �' <br /> Owner (Mortgagor),l ,: ,'% .i.� " — - <br /> Total Fee = �' <br /> Billing Name % �: <br /> Connection By _ " , � <br /> j . <br /> Address Signed ���,�t[r{ ,�d.� ''(``yc-�- <br /> Phone �%�� ? S' %:Z c�sm�ne, � <br /> � <br /> DESCRIPTION: / <br /> Lot ' "� � �ti"� Sewer District_ . F � � <br /> Block� <br /> Plat % - i ' _f Monthly Sewer Service '• � O <br /> Unpiatted Description T r <br /> IMonthly Sewer Constr. <br /> iTYPe Permit: ;�j., , - �.,<_, . /'� �_, ,,� Trunk_ �• �� <br /> k Remarks: Lateral <br /> � Abutting Lot Line <br /> N, S, E, W ft. <br /> I � � <br /> Approved Byy �,f <br /> Gty Engineer <br /> � Issued By - % <br /> I <br /> I <br /> � � <br /> I Inspectior. By •' ' ' <br /> �,, <br /> I o Date Inspected�l�7rf <br /> T- <br /> SEE SKETCH ATTACNED , <br /> � N0. � �_i ;�, i � <br /> � lii. . . 1TI'�f ' �.�, <br /> � � ,.,e_= ...,.= i' , <br /> . � '.w ^Y�!�-'.y .LV ��.qg_ i str� 'r h i�.' �, <br /> _ " ' ___" �..�.'i'° �.. <br /> S <br />